HFMA CRCR EXAM LATEST EXAM 170+ QUESTIONS AND CORRECT ANSWERS(VERIFIED ANSWERS)

HFMA CRCR EXAM LATEST EXAM 170+ QUESTIONS AND CORRECT ANSWERS(VERIFIED ANSWERS) Pre-Service activities 1. Requested service is screened for med necessity, health coverage/benefits verified, preauthorization obtained and estimate to patient oop costs generated within guidelines of NSA and state regulations. 2. Patient notified of financial responsibility including copayment and health plan deductibles, eligibility of financial assistance assessed. 3. Patient is scheduled 4. Encounter record is generated and patient and guarantor info is obtained and updates as part of preregistration. 5. Cost of the scheduled service identified patients health plan benefits are used to calculate the price of the services to the patient. - includes deductible, coinsurance and or copayment amounts. Time of service Financial account review is completed prior to patient visit. Patient arrives at service unit where pre-registration record is activated, consents are signed, copayments and agreed upon amounts are collected. Positive identification is completed, and the patient is given an armband with acct number. Scheduled preprocessed patients report to designated express arrival desk located in centralized area upon arrival. Unscheduled patients - Time of Service Comprehensive registration and financial processing is completed at time of service. Mirroring scheduled patients who is OON with provider furnishing services during their encounter all federal and state transparency and NSA provisions are followed to provide consent to patient of their rights Time of Service steps Case management and discharge planning are provided. Orders are entered. Results are reported. Charges are generated. Diagnostic and procedural coding is completed. ONGOING: Monitor of charges Managed care resolution Patient liabilities resolution, as needed. Ensure health plan requirements and liability calculations change - vet the changes against fed/state guidelines. Consent and updated estimates are communicated to patient and health plan. Post Service Includes the account activities that occur after the patient is discharged until the acct reaches zero balance, such as final coding of all services, preparation and submission of claims, payment processing and balance billing and resolution. Best practices recognize all three critical segments of the contemporary revenue cycle. Each segment includes a series of processes which are specifically designed to ensure accurate data collection, consistent quality, and a high level of patient satisfaction. Preservice - patient is scheduled and registered for service. Patients service costs are calculated. Time of service - Case mgmt and discharge planing services are provided. Consents are signed. Post Service - Bill sent electronically to Consumer ExperienceEach segment of the revenue cycle interacts involving patients. The key to success is establishing a clear and ever present focus on the patient. Patient Experience Patients are demanding info and choices. Regulations are demanding price transparency. For all known charges - even those not employed by the provider. Expect quality - health care and financial care. Health plans care about quality - HCACPS stars is a measure of satisfaction. With poor scores - Medicare will be reduced. Customer Experience Customer service is paramount. Empowering front line staff to provide patient focused solutions is basic component of great patient experience. Best practice communication strategies, scripting and training are good tactics. Healthcare Dollars and Sense HFMA revenue cycle initiatives: Patients Financial communications best practices Best practice for price transparency medical account resolution Financial Discussions In ED Setting - no patient financial discussions should occur before a patient is screened and stabilized, in accordance with local regulations governing the ed. Emergency med conditions If medical screening determines that a patient has an emergency med condition, the financial discussion should occur during the discharge process. For patients who do not have emergency condition following the medical screening, discussion may occur during registration at bedside or discharge process. Non-emergency conditions Outside ED Setting discussions may take place during registration or discharge process in a location that does not disrupt patient flow. If a patient consents to financial discussion during a medical encounter to expedite discharge, best practice supports that choice. Discussions in advance of service Use the most appropriate means of communication for the patient, can occur via outbound contact with the patient, inbound contact from the patient, or scheduling contact at time of appointment. Timeliness of discussion Reasonable attempt must be made to have the discussion as early as possible, before financial obligation is incurred (service) Patients Patients should be given the opportunity to request a patient advocate, family member. Or other designee to help them with discussion. Provision of Care ED Patients should also be informed that their ability to pay will not interfere with treatment of any emergency medical conditions. Uninsured patients - should be informed that the goal of collecting info. Is to identify paying solutions or financial assistance options that may aid them with their financial obligations. OON - must be provided disclosures, notifications and consent according to fed/state regulations. Prior balances Across all lines - it is important to have clear policies on how to interact with patients with prior balances. Providers should have clear definitions of elective and non-elective procedures. Policies should be made available to public. Patients should be informed for non-elective surgeries of that their ability to resolve prior balances with not affect provision of care. Prior to elective - patient should do good faith estimate within state/fed regulations to make payment arrangements. Annual Financial Training Programs Must include: Patient financial communications specific to staff role Financial assistance policies Available patient financing options. Alternative solutions for the uninsured Standard language to be used Laws and regulations. Annual observation Observation, monitoring and tracking of results make up the process of compliance evaluation required to document compliance. Evaluation of technology Ensuring that: Insurance eligibility for current services Existing prior balance for current services Estimated cost of current services and patient responsibility portion. Cost of poor quality patient experiences Loss of future revenue Soft cost - customers passing on info about their negative experience to those they know and social media. QualityNearly 40% of billing information is obtained during the registration process. Registration staff Are the key customer service reps of the org. They should orient the patient to financial procedures and be a resource for questions and concerns. Patient accounting dept. Is charged with the responsibility of account resolutions. They: modify bill formats and statements, extend Normal business hours for patient inquiries, make sure staff answer the telephone courteously. Give patient their names. Billing communication Resolve questions and complaints without transferring to another person if possible. Follow up on customer inquiries within 48 hours, and has customer service as part of their performance plan. Staff should be empowered to resolve routine inquiries and answer difficult questions. consequences of not having communication policiesCan influence billing physicians and case review. Legal issues related to quality failures may be a cons